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. 2008 Nov 20:8:241.
doi: 10.1186/1472-6963-8-241.

Good adherence to HAART and improved survival in a community HIV/AIDS treatment and care programme: the experience of The AIDS Support Organization (TASO), Kampala, Uganda

Andrew M Abaasa  1 , Jim Todd, Kenneth Ekoru, Joan N Kalyango, Jonathan Levin, Emmanuel Odeke, Charles A S Karamagi
Affiliations

Good adherence to HAART and improved survival in a community HIV/AIDS treatment and care programme: the experience of The AIDS Support Organization (TASO), Kampala, Uganda

Andrew M Abaasa et al. BMC Health Serv Res. .

Abstract

Background: Poor adherence to highly active antiretroviral therapy (HAART) may result in treatment failure and death. Most reports of the effect of adherence to HAART on mortality come from studies where special efforts are made to provide HAART under ideal conditions. However, there are few reports of the impact of non-adherence to HAART on mortality from community HIV/AIDS treatment and care programmes in developing countries. We therefore conducted a study to assess the effect of adherence to HAART on survival in The AIDS Support Organization (TASO) community HAART programme in Kampala, Uganda.

Methods: The study was a retrospective cohort of 897 patients who initiated HAART at TASO clinic, Kampala, between May 2004 and December 2006. A total of 7,856 adherence assessments were performed on the data. Adherence was assessed using a combination of self-report and pill count methods. Patients who took <or= 95% of their regimens were classified as non-adherent. The data was stratified at a CD4 count of 50 cells/mm3. Kaplan Meier curves and Cox proportional hazards regression models were used in the analysis.

Results: A total of 701 (78.2%) patients had a mean adherence to ART of > 95%. The crude death rate was 12.2 deaths per 100 patient-years, with a rate of 42.5 deaths per 100 patient-years for non-adherent patients and 6.1 deaths per 100 patient-years for adherent patients. Non-adherence to ART was significantly associated with mortality. Patients with a CD4 count of less than 50 cells/mm3 had a higher mortality (HR = 4.3; 95% CI: 2.22-5.56) compared to patients with a CD4 count equal to or greater than 50 cells/mm3 (HR = 2.4; 95% CI: 1.79-2.38).

Conclusion: Our study showed that good adherence and improved survival are feasible in community HIV/AIDS programmes such as that of TASO, Uganda. However, there is need to support community HAART programmes to overcome the challenges of funding to provide sustainable supplies particularly of antiretroviral drugs; provision of high quality clinical and laboratory support; and achieving a balance between expansion and quality of services. Measures for the early identification and treatment of HIV infected people including home-based VCT and HAART should be strengthened.

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Figures

Figure 1
Figure 1
Kaplan Meier survival estimates in 897 HIV/AIDS patients initiated on HAART in TASO Kampala, Uganda, by Adherence status.
Figure 2
Figure 2
Kaplan Meier survival estimates in 897 HIV/AIDS patients initiated on HAART in TASO Kampala, Uganda, by CD4 count at initiation.
Figure 3
Figure 3
Kaplan Meier survival estimates in 897 HIV/AIDS patients initiated on HAART in TASO Kampala, Uganda, by Education status.
See this image and copyright information in PMC

References

    1. Hogg RS, Heath KV, Yip B, Craib KJ, O'Shaughnessy MV, Schechter MT, Montaner JS. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA. 1998;279:450–454. doi: 10.1001/jama.279.6.450. - DOI - PubMed
    1. Palella FJ, Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med. 338:853–860. doi: 10.1056/NEJM199803263381301. 1998 Mar 26. - DOI - PubMed
    1. Mermin J, Were W, Ekwaru JP, Moore D, Downing R, Behumbiize P, Lule JR, Coutinho A, Tappero J, Bunnell R. Mortality in HIV-infected Ugandan adults receiving antiretroviral treatment and survival of their HIV-uninfected children: a prospective cohort study. Lancet. 2008;371:752–759. doi: 10.1016/S0140-6736(08)60345-1. - DOI - PubMed
    1. Walmsley SL, Becker MI, Zhang M, Humar A, Harrigan PR. Predictors of virological response in HIV-infected patients to salvage antiretroviral therapy that includes nelfinavir. Antivir Ther. 2001;6:47–54. - PubMed
    1. Wood E, Hogg RS, Yip B, Quercia R, Harrigan PR, O'Shaughnessy MV, Montaner JS. Higher baseline levels of plasma human immunodeficiency virus type 1 RNA are associated with increased mortality after initiation of triple-drug antiretroviral therapy. J Infect Dis. 188:1421–1425. doi: 10.1086/379201. 2003 Nov 15, Epub 2003 Nov 1425. - DOI - PubMed

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